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CHAIN OF CUSTODY RECORD Pg of _j— <br /> C FOR LABORATORY USE ONLY: <br /> Advanced Technology Method of Transport �� Sample Condition Upon Receipt <br /> ' Laboratories ROAClient ❑ATL ❑ 1.CHILLED YVN❑ 4.SEALED Y ❑ N ❑ <br /> / <br /> 3275 Walnut Avenue / �9 CA OverN ❑� 2.HEADSPACE(VOA) Y❑ NO 5.#OFSPLS MATCH COC Y ❑ N ❑ <br /> Signal Hill,CA 90755 Logged By: Date: FEDEX ❑ <br /> (562)989-4045 • Fax(562)989-4040 Other: 3.CONTAINER INTACT Y❑ N❑ 6.PRESERVED Y❑ N ❑ <br /> Client: GEOCON CONSULTANTS, INC. Address: 3160 Gold Valley Drive, Suite 800 TEL: ( 916 ) 852-91 18 <br /> Attn: 305Aa 1_f�' f(ZT city Rancho Cordova State CA ZlpCode 95742 FAX: ( 916 ) 852-9132 <br /> Project Name: � p Project#: Sampler: IP nletl"emel (SI#oQ"M <br /> �QtM (y Ei AMD LNDC ��K,�L-OL--07- �O$ea ut �� <br /> Relinquished by:tsl Pr,a 7 �+ Date:. Time: Receivedb :tse pimp w�yy <br /> &5o ¢ OaT- r t� 2 OCQV Y ere�sr-6'N Y ✓' Date: <br /> !L rime:C4 CC. <br /> Relln8W&�grW MLV, Date: 1 )$ Time: LOM Received by:lsgrewm. Pnnlmlam.) ,� Date: VIS 12 Time: (� <br /> Relinquished by.ls¢naw,,,,,a Pnnla u.mel Date: Time: Received by lsy�mand Pnnl.a ramal A ' Dater �c2�y Time: <br /> I hereby authorize ATL to perform the work Send Report To: Bill To: Special in c[IonslCothments: <br /> indicated below. <br /> Project Mgr/Submitter. Attn: Attn: <br /> J-sia Gwi'-Ar t Iv IZcc: Cc: <br /> me Dale <br /> Address Address <br /> si nalure city state—zip City State_Zp_ <br /> Sample/Records-Archival&Disposal Circler <br /> Add SPECIFY APPROPRIATE QA/QC <br /> Unless otherwise requested by client,all samples will be disposed 45 days after Analysis(as) MATRIX <br /> receipt and records will be disposed 1 year after submittal of final report Requested 0 RINE <br /> Storage Fees(applies when storage is requested): CT Elt,J N <br /> •Sample :$2.00/sample!mo(after 45 days) ` qJ > SWRCB ❑ <br /> •Records:$1.00/ATL workorder/mo(after 1 year) La ,� Q <br /> I LAB USE ONLY: sl ` �P ~� m Logeode— <br /> T Sample Description � • ; _? ao eo O e Containers) rn <br /> Batch#: yC� m t o@ 2 J= ti W OTHER_ <br /> E r + om em . O 9 <br /> M Lab No. Sample I.D./Location Date Time 4p" m�'�. 0n. $ yo �e O2 3e TAT # Type ti-I REMARKS <br /> /J00;6/ �0? C01 -1 t,-t 161, 1 ylxlxlE l M I C, A Gr <br /> l <br /> W P <br /> N <br /> CD <br /> i <br /> i <br /> I <br /> I <br /> I <br /> 1 <br /> 1 <br /> I <br /> I <br /> I <br /> 1 <br /> I <br /> I <br /> 0 <br /> I <br /> •TAT starts a a.m.following day it TAT:A= Overnight B Emergency 0= Critical 0= Urgent E–Routine Preservatives: <br /> samples received after 3 p.m. 5 24 hr Next Workda 2 Workda s 3 Workda s 7 Workdays H=Hcl N=HNOa S=H,SO, C=4'C <br /> Container Types: T=Tube V=VOA L=Liter P=Pint J--Jar B=Tedlar i G=Glass P=Plastic M=Metal Z=Zn(AC), O=NaOH T=Naas:O, <br /> nmroionnnni. url.:•e„a r..o....n Vullnm fn Wdnr Pink M cuhmiffnr <br />